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General NPI Number Information
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NPI Number | 1730831850
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Entity Type | Individual
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Provider Name | MADISON KIRSTEN GABRIEL BS
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Gender | Female
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 6926 SHANNON WILLOW RD STE 400
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City | CHARLOTTE
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State | NC
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Zip | 28226-1335
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Country | US
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Telephone | 704-343-5005
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Fax |
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Provider Business Mailing Address
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Address Line | 300 STATE ST APT 334
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City | KNOXVILLE
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State | TN
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Zip | 37902-1188
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Country | US
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Telephone | 203-822-2700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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